WORK INJURY REPORT

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
123674	WORK INJURY REPORT Form	Migrated

ICR Details

OMB Control No: 1220-0047	ICR Reference No: 198612-1220-002
Status: Historical Active	Previous ICR Reference No: 198304-1220-004
Agency/Subagency: DOL/BLS	Agency Tracking No:
Title: WORK INJURY REPORT
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/30/1987
	Date Received in OIRA: 12/03/1986
Terms of Clearance: The proposed survey is approved through March 1988 subject to conditio outlined below. You will: 1) mail a sample questionnaire to all potential sample cases, including cases for which there is insufficien information to determine whether the case is in scope, 2) develop alternative cover letters in an effort to improve survey responses through a more open discussion of the confidentiality of survey result and the importance of the survey, 3) prepare a plan for the comparisio of responses in different States to reveal potential biases, 4) arrang for followup telephone calls to all nonrespondents during nonbusiness hours, 5) submit the questionnaires and the written survey procedures, including a plan for the analysis of the response rate, to OMB for approval before use, 6) provide lists of the States participating and those not participating in this survey, including reasons for the nonparticipation of individual States, and a short explanation of the programatic differences between WIR and nonWIR States, and 7) submit all proposed revisions to the material described in item 5 for expedited OMB review and approval before use. In addition, we suggest that draft questionnaires and other materials be submitted to OMB in order to shorten the formal review period. We would also encourage small (9 or fewer) pretests of questionnaires and cover letters for th sole purpose of improving their design.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/1988	03/31/1988
Responses	750	0	0
Time Burden (Hours)	125	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THE WORK INJURY REPORT PROGRAM EXAMINES SELECTED TYPES OF WORK INJURIES/ILLNESSES TO DEVELOP INFORMATION BASED ON THE DATA NEEDS OF THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION. THE CURRENT SURVEY WILL FOCUS ON INHALATION OF TOXIC SUBSTANCES AND ASSIST IN THE DEVELOPMENT OF SAFETY STANDARDS, COMPLIANCE AND TRAINING PROGRAMS.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
WORK INJURY REPORT	BLS 98P

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	750	0	0	750	0	0
Annual Time Burden (Hours)	125	0	0	125	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/03/1986

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